ABSTRACT
Objective To evaluate the anesthetic efficacy of different doses of dexmedetomidine combined with ketamine in the pediatric patients undergoing closure of ventricular septal defect.Methods Ninety pediatric patients with ventricular septal defect requiring interventional treatment,aged 4-11 yr,weighing 12-47 kg,of ASA physical status Ⅰ or Ⅱ,were randomly divided into D1-3 groups (n =30 each) using a random number table.After admission to operating room,anesthesia was induced with iv atropine 0.02 mg/kg and ketamine 1.0 mg/kg,followed by administration of a loading dose of dexmedetonidine 0.5 μg/kg which was infused over 10 min.In D1,D2 and D3 groups,dexmedetomidine 0.7,1.0 and 1.2 μg· kg 1 · h-1 were infused intravenously,respectively,until the end of operation.After the pediatric patients lost consciousness,the femoral artery was punctured to perform interventional treatment.Additional ketamine 0.5 mg/kg was given when the depth of anesthesia was inadequate.BIS,BP,HR and SpO2 were recorded after admission to the operating room (T0),at 1 and 5 min after ketamine administration (T1,2),at the end of loading dose of dexmedetomidine infusion (T3),at 15 min after maintenance dose of dexmedetomidine infusion (T4),immediately after operation (T5),and immediately after emergence (T6).The total consumption of ketamine,cases who needed additional ketamine and atropine,operation time,emergence time and development of adverse effects such as respiratory depression and postoperative agitation were recorded.Results Compared with the baseline value at T0,BIS value was significantly decreased at T4,5 in the three groups,HR was decreased at T4,5 in D2,3 groups,and no significant change was found in BP and SpO2 at each time point in the three groups.Compared with D1 group,the requirement for additional atropine was significantly increased,the total consumption of ketamine was reduced,and the requirement for additional ketamine and incidence of respiratory depression were decreased in D2 and D3 groups.No patients needed additional ketamine in D2 and D3 groups.The requirement for additional atropine was significantly higher in D3 group than in D2 group.There was no significant difference in the operation time and emergence time among the three groups.No pediatric patients developed agitation during emergence from anesthesia.Conclusion Ketamine 1.0 mg/kg (for induction of anesthesia) combined with a loading dose of dexmedetomidine 0.5 μg/kg and maintenance dose of dexmedetomidine 1.0 μg·kg-1 · h-1 (for maintenance of anesthesia) can produce good anesthetic efficacy,which is an optimum combination of anesthesia in pediatric patients undergoing closure of ventricular septal defect.
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Objective To observe the efficacy of radical nephrectomy plus embolectomy for the treatment of renal cell carcinoma with renal vein or inferior vena cava involvement. Methods Clinical and pathologic data of 8 patients with renal cell carcinoma extending into renal vein or inferior vena cava were summarized.The operative essentials were introduced,and survival periods were followed up. Results A total of 8 patients underwent radical nephrectomy plus embolectomy.One patient died during the operation after embolectomy with exhausted respiration and cardiovascular function.Three patients survived for 2,4 and 22 months respectively,but all died of distal metastasis later.Four patients were alive for 2,14,25 and 47 months respectively after operations till writing of this article. Conclusions Radical nephrectomy plus embolectomy is a valuable method for the treatment of renal cell carcinoma with renal vein or inferior vena cava involvement.
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Objective To observe the changes in acid-base balance and the contents of electrolytes in patients during liver transplantation to explore the relationship between such changes and ASA grading, and to look for an optimal anesthetic intervention. Methods Arterial pH, PaO_2, PaCO_2, HCO~-_3, BE, K~+, Ca~ 2+ , Na~+, and glucose were monitored in 89 patients undergoing liver transplantation at four specific periods: before anesthesia (T_0), after skin incision (T1), 10 minutes before reperfusion (T_2), and 10 minutes after reperfusion (T_3). Changes in blood acid-base and electrolyte parameters of the patients with different ASA status were compared. Result The pH and BE in ASA V patients was significantly lower at T_0, T_1, T_2 and T_3, and HCO~-_3 was lower in ASA V at T_3. The PaCO_2 in ASA V patients was significantly higher at T_0, T_1 and T_2. The Na~+ content in ASA V patients was significant higher at T_2 and T_3. At T_0 and T_1, the glucose level in ASA Ⅳ and Ⅴ were significant higher than in ASAⅢ. Significant differences in pH, PaCO_2, HCO~-_3, BE and glucose level were observed at different stages of the surgical procedure. The pH, BE and HCO~-_3 were significantly lowered at T_2 and T_3. Mean glucose and HR levels were gradually increased from T_1 to T_3. Conclusion Patients with advanced ASA grades are more prone to acid-base and electrolyte disturbances during reperfusion of the liver transplant. High ASA grades contitute an increased risk for cardiovascular collapse after reperfusion, calling for proper treatment.